BACKGROUND: Football injuries pose substantial risks to player health, team performance, and club finances. Although injury prevention is a key priority, most epidemiological studies focus on short-term data from international tournaments or clubs outside Germany. This study aimed to examine the injury epidemiology in German elite men`s football through a long-term analysis of a single club competing in both top national leagues. METHODS: A professional German football team was prospectively observed over eight consecutive seasons, with four seasons played in the first division and four in the second. Injury incidence and associated time loss were analyzed using Poisson regression. RESULTS: A total of 357 match injuries and 625 training injuries were recorded. Injury incidence did not significantly differ between the first and second division, either for match play (79.0 vs. 80.8 injuries per 1000 match hours, P=0.83) or training (8.7 vs. 9.2 injuries per 1000 training hours, P=0.49). However, average time loss was significantly greater in the first division for both training injuries (70 vs. 49 days per 1000 training hours, P<0.01) and match injuries (653 vs. 596 days per 1000 match hours, P=0.017). CONCLUSIONS: Although injury incidence was comparable between the two top German divisions, injuries sustained in the first division led to significantly greater time loss. These findings highlight the importance of addressing not only the frequency but also the severity of injuries in elite football injury prevention strategies.
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